WQ0041987_Application (FTSE)_20200917

staic of forth Carolina
DWR
Departrncnt of E:n►ironmental (lualiq
l)i� Trion of 11':ttrr ltrssturrc
iDlvlslon of Water Resources 15 ► V ►( 021 .0300 - FAS 1"1 It ►(. 1• tiF ►� t.lt SI S I F ►1 F \l f NSIO\ APPLIC VI 10%
l IA 04-16 S S1 1 f 01111`G DOC I ►lE\"I" Cl ION
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1ppl�can0m \urtlhcr' [� VQ �lq3 iwK- —r.rtcdhti D%hIQ
All item, mu,t hr_rumtrlrtrd nr the nnalieulian Aill be returned
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I. AI'E'LIC"A 1'1'11FUR►LtII(l\ ��(/�ta
t I: ,►ppGc:rnl'; name "loon of (;,+Id,ton rcomp,tn}, rnunicipal+n . I It)1, utcht) rt, i � 3 C C
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'_ Applicant tree. ❑ Indir+dual ❑ Corporation ❑ General Partne"htp ❑ Prisatel) -[la
Public ( tilny
❑ I cdcral ❑',talc Count. (] Vumupal ❑ Uthcr
3. Signature authartWs name I in j (-L p per I � t `( 1c (1' f. rrtUr+Lhi
Fide \ tt.spr
4. Applicant', mailing, addrms. I'll Rtok 5'7
Cit., Goldstar] St.nc \(. Jrp
S. Applicant'; contact rnlonnatwn
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!'hone number fcticat t{�+A-�taai Email Wdrrss' nn+cunnudricmt±arcEmatl com
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+ I1. 1'RO3Fcl 1\F(1R► A,11(1N:
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I. Project name Pha,c II Se%%Cr M,tcm Inmrmemc_nis
2. Apphcanon Prr ject status [D Proposed I\c%v 1'emlitl ❑ Existing f'crmitl'ruject
11'a modification, pro%ode the c,attng pemnt number. %%QOfi turd issued date
,
If acts construction but pan of a master plan prostdc the ca,snng permd nwnhcr U 000__
o n csl
1. Ctountl +there project is ktcatcd (hathpn
a. \ppraatmalc Coordrmdes I Ilccirnal i)cgrccs+ latitude 35 609'All I on�itudc-19.11.Ict11
"'
7
5. Parcel 10ltl'appltcablet:
(ur Vartcl ID to closest dos,nstream Sc%%crr
III. CO\St 1.1 AN I I\ FORM ATIOV
I. Professional I mincer" .Michael Wicker I rcense \umber 111?S
I irm: 11 ithrrsRa%encl
►taihnr;address; I"Ik �t.�cl�cnanf)ritir
Cit)- Curti State M, lip.'751
Phane number inter)► ar+q-??an I'mail Address mstickcra v iihrrsrascne1 corn
IV. 11'ASTf.11 XI f R l RLA1 NIEN'I FACI1.I1-1 0% N I.0 IN FORA %l ION:
Faciirt) \amc flit: l:luffala 11 WTP Permit \umber \('00241 a7
Owner \,tmc. C-tr o� I'Sanf Prdrrd
V. RLCF:111\(i f)O11 \ti,IRrAM SF%%,I-.it I\1"()1t11,171ON Iifdifferenl ]hart 11'11'I F):
1" Permit \umherlsl, %kQ00360(v7 Do"ustream iftecciaing) 5csrcrSvc 8 inch
til ctem 11 idr (", Ilccttun 5% stem l'crtnu \urnhcn, il.JP,itcable ; 11 QCSD
Owner \antcl sl Tm►n of Goldstnn
I'OR%l I I A 0.4.1h f agC I of 5
I

V1. GENERAL, REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of public Convenience and Necessity been attached?
❑ Yes (--]No ®N'A
2. If the Applicant is a Developer of lots to be sold, has a De%elo ier'.s Operational Agreement FORA: D E__VJ been attached?
❑ Yes [:]No ®N;'A
3. If the Applicant is a Home: pronerty O%ners' Association, has an Operational Agreement (FORM_I IOA) been attached?
❑ Yes ❑No ®N;'A
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparationlservice ❑ Hotel and;'or Motels
❑ School 1 preschool f day care ❑ Medical 1 dental 1 veterinary facilities ❑ Swimming Pool ;'Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool+Filter Backwash
® Businesses � offices 1 factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % DomesticlCommercial % Commercial
% Industrial (See 15A NCAC 02T_,0)0i(2_Q))
bIs there a Pretreatment Program in effect'? ❑ Yes ❑ No
6. Has a Flow reduction been approved under I5A NCAC 02T .01 14(1)7 [:]Yes ® No
:w If ves, provide -a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(B]
Daily Design Flow"'
No. of Units
Flow
Dwelling Units
360 galihouse
38
13,680 GPD
General Business (Marsh Auto Repair)
25 gal employee*4 employees
1
100 GPD
gal.'
GPD
gal,
GPD
gal;'
GPD
gal;'
GPD
Ta1n1
13,780 GPD
a See 15A NCAC 02T .0I 14(h), (d). (e)(I) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 13,780 GPD (per 15A NCAC 02T .0114)
i- Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of

\'11. GRAVITIii- SE%%F.R DFSIG\ CRI'I'F:RIA (If Applicable) - 021 .0305 & ►iM iGravity Sewers):
1. Sumntatize 6ritvitysewer la be permitted:
Size (inches)
length (fret)
Material
8
2780
PVC
8
200
(AP
i
0f'
�' VrX
Section li & III of the %IDC for Permitting ot'GraNity Se%VLT4 contains information related to deign criteria
r Section III contains infurmation related to minimum stapes firr gravity scwerls)
i Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
\ Ili. PUMP S'IA I ION ULSIG\ CRI FERIA (1rApplicable)—t12I'.03t1z & Nil)(' {Punta Statiuns!Force %lainsl:
CO**IPLF:TF FOR EACH PGS1P STATION I\CLIAWD IN TII1S PROJECI
1. Pump station number or name: Pinecrest Road PS
?. Approximate Coordinates (Decimal Degrees): Latitude: 35.604234 Longitude:-79.314265
3. Design flaw of the pump station: 0.173 millions }gallons per day I firm capacity)
4. Operational pointts) of the pump(s): 10 gallons per minute at 60 feet total dy namic head (1 W i I
5 Summarize the faro main to be permitted (fur this Pump Stationh
Sire (inches)
Length (reel)
NIalerial
4
1657
PVC
4
76
DI1'
6 Power reliability in accordance with 15A .tiCAC 021 03051 h h I is
0 Standby power source or pump with automatic activation and telemetry - 15A \CAC 027f .0305(h)( 1)(131-
Required for all pump stations with an average daily flow greater than or equal to 15.000 gallons per day
Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day-
❑ Portable power source with manual activation. quick -connection receptacle and telcmeq - 15A NCAC 02T
03051ho I)((-)
or
❑ Portable pumping: unit with plugged cmcrgt:ncy pump connection and teletnrtry - 15A XCAC 02T 0305(h)(I KC):
It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station
If the portable power source or pump is dedicated to multiple pump stations, an evatuation ofall the pump slanons'storage
capacities and the rotation schcdult: of the pormbtc power source or pump. including travel timefrarries, shall be provided
in the case Ufa multiple station po%%cr outage
I UR%I I FA 04-16 Page 3 of 5

Ix. SEI-BACtis & .SEIV U VI 10-SS - (0211.0200 & 15.4, %CAC 021 .0305(i)):
1 does the project comply %%ith all separatons found in 15 A M ,fit Q 427-0101 ❑ Yes ❑ �u
i I'_sr'n'�rnYA.,A :..........�...._ L_._L..HL _ ...._.r..- --,....-..
-_ Scibaek Paramc(ar•
St. aration Re tared
5tarm sewers and other utilities not listed helmN ivenical1
24 inches
1h'ater mains (tcrtical-water over saber hOudin g in beached trenches)
18 inches
M ater mains 1 horizontal)
10 feet
- IS inches
_ _ _ _
Reclaimed tvater lines iiwrtical - reclaimed over scµcrl
Reclaimed %valcr linesthoritontat- reclaimed o,.cr scwcri
--Any private ar public water supply source, including any wills, 11 ti-I watch of Class E or
Class 11 im Quailed rescnoin used as a source of drinking %saner
_ 2 feet
�T'^
100 fret
•' 1� acerb classified WS [except %l S-1 or 11 S-1'1. 13, SA. OlM, I IQN%. or till from normal
high water lot trdc elevation) and wetlands i sec item 1.X 21
r
50 feet
_
6•,-1ny other stream, lake, impoundment. or ground +safer lowering :utd surface drmnagc
dltchcb _
10 feet
UN buildine foundation
An% basement
5 feet
10 feet
10 feet
5 Icet
_
Ta s M of embankment or cuts of 2 Icct or nwrc %crtical Ireieht-_
Drainage 5,, stems and intcrccc'Ftor drains _ -� _
An% mwimmmg pools
10 feet
� _ _
i final earthLade (ycrtic;LlP _ _ _ _ _ _ _
R 36 inches_._
15A WAC 021 0105i u! cunwir,s altcrnatitcs where separations in ii 21 tl3054 ti cannot be aehtcvcd,
•'Stream classifications can be identified using the l}isisian's \f tiurla�c «ater (Jasstricanons Hehnaee
i If noncompliance tsith 021 r Vi5i f i or to i, see Section \ of this application
2. Does the project comply with separalien requirements for tvcl ands? 150 feel of separation) ❑ Yes ❑fit, [] `.
r See the Division's draft separation riAIWrMWnb for situations where separation cannot be meet
r No variancc is required if the altcmativc design criteria specified is utilized in design and construction
As built documents should ref ercnct the location of areas cticctcd
3 Does the projcct comply is ith setbacks found in the river basin rules per.! i 1 \_C >_C 412B .W_001 ❑ Yes ❑ NO ❑ VA
1 his %could include) rout Buffered Sirtams per 15A WAC 2B 0202
4 Dro-es the project require coverage'authoriration under it 404 Nationwide or ❑ Yes Q No
indiv?dual permits or 401 Water Quality Certifications?
e information can be obtained from the 41l l & Buller Permittioke 11r.I01ch
5 hoes project comply tsilh I5A X('AC (12 FJM)51cii() (additional pertnityccnift[cations)'' ❑ t cs ❑ %0
Per I `�%y"\riC I fi 11151eriCii, directly rtlatcd cnvironntcrital permits or ccnilicalion applications arc being prepared, have
been applied for. or have been obtained Issuance of this permit is contingent on issuance oFdependent permits (erosion and
sedimentation control plans, stormwater rn magcment plans, etc.l.
b. Does this projcct include any sewer collection lines that are deemed "high -priority?"
Per 15A `sC %C 021 04Q2. "higll•priority sewer" means "any aerial setter. sewer contacting surface waters, siphon, or sewer
positioned parallci to strcwnbanks that is subject to erosion that undermines or delcriomtei the sewer
❑ Yes Q ,So (J \+A
r Ifycs, include an attachment Kilh details liar each line, including 1)pc (aerial line, site, malcrial, and location).
Iligh priority lines shall be insprcled by the permitter or its rcpresentalltt at least once ever} six-munthsand inspections
ducumented per 15A SC'AC 02 i.0403(a)(5) or tlic perrnllee's individual by stern-11 ide Cutleclinn permit.
I4RM IIy04-15 Page 4uf5

I, "on 111c suhuriticd %ystcnl unholy with 15 k V 11. f121-, the Motmillsrii ),fin ( ril, n t +s ilrr I'tn1ri;ts+r! r11 flrrure Staff+ us
nrtd fnrcc \lain, (Ialelt sows-11i and the _Q11j , ,VMi,I Mpossumit I1ClICn Citterla IL1tcA �cl4Lgl).. flp}111CaIYle7
t] Yes ❑ No
If No, complete and subluil the VarlancelAllenlalivc design ICequcst aPplicatiou (VADC 10-14) uud suppuriing docuuleats for
lcvic%v. ,\ i u oval of (lie request fs retluirell Imfill-in submittal of the hast'frsicli A r iliralinrt and 4m t ,nrthi , tinrururim
!. 1'1016sional Hugutcet's Ccrtilicamuu
[ Mit h:ICI Wicker _ _ ___attest That this application for
(11rofessiotlal Fliguiccr't n:lnic from Application Item III 1 )
has becit reviMcd by [lie :mid is accurate, complete and eousi:,leot wills the i nfnnualinn supplied in the platts, spceiftcalions,
engineering calculations, and all 0111cr snppulting dntunicntitlloll 10 !hc hest of illy knowledge. I finthcr attest that to the best
of lily klio%vlcdgc Zile plopascd dcstgu Ills been prepared lm accord:utce wills the applicable regulations, Gravity Sc%ver
Minimum Design Viiiemt 114u Cilavity Sv%%Lj.% hcti! vcrsiun), 1112d the i%Iolioun, Ucsign Clitcria for the lust -Track Nermiltatg
Of Ktall, Stations and Forcc Mains (latest Vclslau) Although utIM 11t0leSSIMMIS May have developed ccltalll portions of Ilrs
slibnlimal package. Inchisiun of these materials tinder lily signature and sc 11 sibnilics that I have reviewed this ntatciial and
have judged it to he consistent with the proposed design
nnrr•_ -- Ill aea01da1,ce will, ticnctal Statutes 1.13-215.6A and Id3-215 611, any person olio knowingly makes any fa sc
statement, mprescnralloa, or eeltiticahois in any application pack.,be %hall lie guilty of a Class 2 misdcnieanor, which may
utclade a fiat not to exceed S10,000, as %veil as civil penallies tip In S25,00t1 per violation
North Curnlhla I'lufcs%inn:11 i:ngin eer's seal, signature, and dale: �•`��>1 CAR�1�•S
DocuSigned by:SEAL
{�4a,it;SSrp�gr ;q
9/15/2020 1325
EC172CEAU882C404... '•��.y. Glt .r; ��
3 Apl-Iicaut's Ceilificatinu per I SA NC AC 02 f .010tr(b)
'I'umothy J. Cunttup, Mayor , Town of Goldst
I, _ ar attest that this application for
(Signature Authority's name & title from Application Item 13.)
has been revic%%cd by the and is accurate and complete to the hest of illy knowledge I understand that ifall required parts of
this apphcanort are not completed and llim il' all requited supporting docnutcntation and atlachmemts are not included, this
application package is subject la being returned as incoruploc I Understand thal any discharge of wastew-nter from this nan-
discltarzc system to surface waters or the land tivill result in an munediate enforecnienl achan that slay include civil pellalues,
utlunowe relief, andlor criminal pioseeulion I %%111 retake oo claim against the division of IVaicr I2esoinces should a condition
of this permit be viulaicd I also understand than if ;ill requited parts of this application package are not completed and that if
A required supptnting infwntalion and allachnlemis nre not included, this application package will be returned to nic as
incomplete.
NO I I - In accordance with Creneral Statutes 141`2Ili _ri N and 141-113 At1, any pclwu whu knowingly milkes any faisc
s atcmcot, mpreseulalson, or certik triou in any applicaliou package shall be guilty of a ['[ass 2 misdemeaaar, which may
nickide m fine unl in exceed S10,000 is well as civil pcoallies up to S25,000 per violation,
i ,ualarc — i JIWC/
r
r� C-1AMvlin
F-
hale: _9_:_i ;- —. W _
If OW I fA04-[6 Page 5of5

rs
%%I WithersRavenel
September 15, 2020
North Carolina Department of Env--ronmental Quality
Division of Water Resources
3800 Barrett Drive
Raleigh, NC 27609
Attn- Jason Robinson. Engineer
RE- WR Project #08180741 00
Fast Track Sewer System E►tens-on App:.ication
Town of Goldston
Phase II Sewer System Improvements
Dear Mr- Robinson
NC Di.ty ofFn�irnnmentalQ11,114
SE P 17 1020
<aleigh Regiott.11 Office
Please find enclosed a Fast Track Application for the Town of Goldston Phase II Sewer System
Improvements Project. The project cons,sts of the installation of approximately 1733 LF of A' force main
2961 LF of 8' gravity sewer and 15 manholes to extend sewer service to a currently unsewered area along
Pinecrest Road and Pittsboro Goldston Road The project will also include the installation of a new 120 gpm
pump station. This project will provide sewer access to 26 existing properties. including one business.
However, a sewer service and cleanout will be installed at the road right-of-way for a total of 38 service
laterals. The project will connect to an existing gravity sewer located along Pittsboro Goldston Road.
Additional flow From this protect is expected to be approximately 9100 gpd. The pump station is sized fora
slightly larger flow due to the presence of several undeveloped properties along the alignment.
Items included in this submittal
• Two copies of Fast Track Sewer System Extension Application
• Two copies of an FTSE 10-18 for the Town of Goldston
• Two copies of an FTSE 10. 18 for the City of Sanford
• Two copies of USGS and aerial site maps
• Application fee
If you have any questions about this submittal, please do not hesitate to call me.
Sincerely,
WitherSRavenei
M LCjti� G ln1%C�
Michael Wicker, PE
Project Manager - Utilities
WithersRavenel
828-255.0313
cc Tim Cunnup. Town of Goldston
:1-. Ma.vpoan Ditye I Car, NC 27511
s• a .i;, f 9if; »o•f (")s :•.ithpr,ravenel,cam j Lkense ND
C.-iry Gs ,cnsboro j Pitt$bWC j Ralri;h [ W.?Mingtor

•
ti

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Town ofGoldston
Project Name for which flow is being requested: Phase II Sewer System Improvements
More than one FTSE may be required for a single project if the amner of the IVIVTP is not responsible fur all pump
stations along the route of fire proposed wastewaterJlou:
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: N,'A
b. WWTP Facility Permit #: N/A
A11 flows are in MGD
c. WWTP facility's permitted flow N/A
d. Estimated obligated flow not yet tributary to the WWTP NIA
e. WWTP facility's actual avg. flow N/A
f Total flow for this specific request N/A
g. Total actual and obligated flows to the facility N.'-'A
h. Percent of permitted flow used —N.--'A
It. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design
Average Approx. Obligated,
Pump Pump Daily Current Not Yet Total Current
Station Station Firm Flow** Avg. Daily Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pO, Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
Vernie P WQ0037122 0.18 0.042 0.0094 0.01378 0.02318 0.01882
Main St WQ0036067 0.288 0.115 0.019 0.01378 0.03278 0.08222
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Goldston Wastewater Collection System
Downstream Permit Number: WQ0037122
Page 1 of 6
FTSE 10- I 8

III. Certification Statement:
I Timothy J CLinnup certify to the best ol'my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated alon'_ the route to the receivine
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances. given the implementation of the planned improvements
identified in the planning assessment where applicable This analysis has been performed in accordance
with local established policies and procedures using* the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
'-� �i- 7 / - ""% $
S4,1liv OPirial 1
Mayor, Town of Goidston
mfn of Gcd�stan
r1 t� n��S711iowg Ojjieial
Niue 2 of 6
3— z .q-6
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DocaSign Envelope ID. 1640EA81-1758-4DE1-93D2-951DB9EE9B75
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Town of Goldston
Project Name for which flow is being requested: Phase I1 Sewer System Improvements
411ore than one FTSE nu r he required for a single project if the owner of the IVII TP is trot respott.sihle for rill ptttrtp
stations along the route of the proposed wastervaler flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Big Buffalo Treatment Plant
b. WWTP Facility Permit #: NCO024147
All flows are itt AIGD
c. WWTP facility*s permitted flow I2.0
d. Estimated obligated flow not yet tributary to the WWTP 1.0608
e. WWTP facilit)'s actual avg. flow 5.733
f. Total flow for this specific request 0.01378
g. Total actual and obligated flows to the facility 6.8076
h. Percent of permitted flow used 56.7%
IL Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated.
Pump Pump Average Approx, Not Yet Total Current
Station Station Firm Daily Flo"** Current Tributary Flo" Plus
(Name or Permit Capacity, * (Firm I pl). Avg. Daily Daily Flou. Obligated Available
Number) No. MOD MOD I;lo", MGD MGD Flo" Capacity`**
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Sanford Collection System
Downstream Permit Number: WQCS00047
Page 1 of 6
FTSE 10-18

DocuSign Envelope ID 1640EA81-17584DE1-93D2-951DB9EE9B75
III. Certification Statement:
I Paul Weeks, Jr. PE certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
DOCUSigned by' ,
At. Wuts 11/4/2020
BBC39E£6878�B@
Signing Of Signature
City Engineer
Title of Signing Official
Dale
Page ? of 6
MP 10-18